The impact of a patient’s concordant and discordant chronic conditions on diabetes care quality measures

Abstract

Aims Most patients with diabetes have comorbid chronic conditions that could support (concordant) or compete with (discordant) diabetes care. We sought to determine the impact of the number of concordant and discordant chronic conditions on diabetes care quality. Methods Logistic regression analysis of electronic health record data from 7 health systems on 24,430 patients with diabetes aged 18-75 years. Diabetes testing and control quality care goals were the outcome variables. The number of diabetes-concordant and the number of diabetes-discordant conditions were the main explanatory variables. Analysis was adjusted for health care utilization, health system and patient demographics. Results A higher number of concordant conditions were associated with higher odds of achieving testing and control goals for all outcomes except blood pressure control. There was no to minimal positive association between the number of discordant conditions and outcomes, except for cholesterol testing which was less likely with 4+ discordant conditions. Conclusions Having more concordant conditions makes diabetes care goal achievement more likely. The number of discordant conditions has a smaller, inconsistently significant impact on diabetes goal achievement. Interventions to improve diabetes care need to align with a patient’s comorbidities, including the absence of comorbidities, especially concordant comorbidities.

Stratifying Patients with Diabetes into Clinically Relevant Groups by Combination of Chronic Conditions to Identify Gaps in Quality of Care

“…; Healthcare Cost and Utilization Project ; Magnan et al. ). Each patient's concordant chronic conditions were identified by ICD‐9‐CM codes billed at one or more clinical encounters during the baseline year.…”

“…including a patient's specific comorbidities, socioeconomic factors, insurance status, health beliefs, and other patient contextual factors (Bayliss et al 2014). The role of comorbidities in diabetes care cannot be overlooked as over 80 percent of patients with diabetes have multiple chronic conditions (diabetes plus at least one comorbid condition) (Bae and Rosenthal 2008;Magnan et al 2015c). Conceptual and early analytic studies have suggested that patients' comorbid conditions can alter their care quality and morbidity, even after controlling for patient demographics and health care utilization (Piette and Kerr 2006;Lee et al 2007;Magnan et al 2015d).…”

“…Stratifying patients into mutually exclusive subgroups based on their combinations of conditions will be most meaningful if the combinations of conditions are clinically relevant. A conceptual model of comorbidity in diabetes suggests that concordant conditions (conditions that share care goals and/or pathophysiology with diabetes) improve diabetes care, and patients with more diabetes-concordant conditions have been shown to be more likely to achieve diabetes metrics (Piette and Kerr 2006;Magnan et al 2015a). In addition, diabetes-concordant conditions are relatively common in diabetes, adding to their clinical importance as combinations of these common conditions will lead to prevalent subgroups of patients.…”

“…HSR: Health Services Research 53:1 (February 2018) retinopathy, and other chronic eye conditions, coronary artery disease, myocardial infarction within the past 2 years, congestive heart failure (CHF), and cardiomyopathy. To identify each patient's concordant conditions, we used our previously developed set of chronic conditions, identified from AHRQ Clinical Classification Software condition categories using the Chronic Condition Indicator, and modified to incorporate ICD-9-CM updates (Hwang et al 2001; Healthcare Cost and Utilization Project 2011; Magnan et al 2015a). Each patient's concordant chronic conditions were identified by ICD-9-CM codes billed at one or more clinical encounters during the baseline year.…”

Association of Multimorbidity with Mortality and Healthcare Utilization in Chronic Kidney Disease

“…If pain management with NSAIDs is prioritized over reducing risk of CKD progression, patients may be at increased risk of acute kidney injury or worsening hypertension . The presence of concordant conditions may increase the likelihood of achieving chronic disease management goals as has been shown in diabetes . In contrast, having co‐occurring discordant/unrelated conditions may also complicate chronic disease self‐management or meeting quality of care goals .…”